Provider First Line Business Practice Location Address:
10803 SE KENT KANGLEY RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030-7194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-569-9625
Provider Business Practice Location Address Fax Number:
253-981-4963
Provider Enumeration Date:
06/18/2012